Irish Journal of Medical Science (1971 -)

, Volume 183, Issue 4, pp 549–556 | Cite as

Evaluation of the effect of intra-operative intravenous fluid on post-operative pain and pulmonary function: a randomized trial comparing 10 and 30 ml kg−1 of crystalloid

  • B. D. Straub
  • A. Aslani
  • K. Enohumah
  • R. Rahore
  • I. Conrick-Martin
  • D. Kumar
  • M. Campbell
  • P. Dicker
  • E. Mocanu
  • J. P. Loughrey
  • N. E. Hayes
  • C. L. McCaul
Original Article



Existing evidence suggests that administration of intravenous fluids has been shown to improve outcomes including pain in gynecological laparoscopic surgery but the optimum fluid dose has not been determined.


To determine the effect of administration of intravenous fluids on post-operative pain and pulmonary function after gynecological laparoscopy.


In a prospective randomized double-blinded study 100 ASA 1 and 2 elective patients undergoing gynecological laparoscopy were randomized to receive intravenous compound sodium lactate 10 ml kg−1 (CSL10-restrictive) or 30 ml kg−1 (CSL30-liberal) administered intra-operatively. The primary outcome measure was the post-operative pain score at 24, 48 and 72 h, assessed by 0–10 verbal rating scale (VRS). Pulmonary function (FEV1, FVC, PEFR) and oxygen saturation were also measured.


Patients who received CSL 30 had lower post-operative pain scores than CSL 10 (ANCOVA—mean difference = 0.47, 95 % CI 0.11–0.83, P = 0.01). Post-operative pain VRS was lower in CSL30 than CSL10 at 48 h (mean difference 0.56, 95 % CI 0.04–1.09, P = 0.036). Patients in CSL30 reported shoulder tip pain less frequently than those in CSL10 (30.4 vs. 43.9 % of assessments, P = 0.03, OR 0.58) but reported wound pain more frequently 39.0 vs. 24.2 %, P = 0.01, OR 2.0). Indices of pulmonary function did not differ between groups at any time.


Liberal compared to restrictive administration of i.v. crystalloid is associated with a clinical modest reduction in pain. Pulmonary dysfunction was not increased with liberal fluid administration.


Fluid i.v Ambulatory Pain Complications Anesthesia-general Laparoscopy 



This work was supported by internal funds of the Department of Anaesthesia of the Rotunda Hospital Dublin. The authors are grateful to Professor Brian Kavanagh, University of Toronto for his comments on the manuscript.

Conflict of interest

None of the authors has any conflict of interest.


  1. 1.
    Yogendran S, Asokumar B, Cheng DC et al (1995) A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 80(4):682–686PubMedGoogle Scholar
  2. 2.
    Maharaj CH, Kallam SR, Malik A et al (2005) Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesth Analg 100(3):675–682PubMedCrossRefGoogle Scholar
  3. 3.
    Magner JJ, McCaul C, Carton E et al (2004) Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg(−1). Br J Anaesth 93(3):381–385PubMedCrossRefGoogle Scholar
  4. 4.
    Apfel CC, Meyer A, Orhan-Sungur M et al (2012) Supplemental intravenous crystalloids for the prevention of postoperative nausea and vomiting: quantitative review. Br J Anaesth 108(6):893–902PubMedCrossRefGoogle Scholar
  5. 5.
    Chappell D, Jacob M, Hofmann-Kiefer K et al (2008) A rational approach to perioperative fluid management. Anesthesiology 109(4):723–740 (p 710)PubMedCrossRefGoogle Scholar
  6. 6.
    Ali SZ, Taguchi A, Holtmann B et al (2003) Effect of supplemental pre-operative fluid on postoperative nausea and vomiting. Anaesthesia 58(8):780–784PubMedCrossRefGoogle Scholar
  7. 7.
    McCaul C, Moran C, O’Cronin D et al (2003) Intravenous fluid loading with or without supplementary dextrose does not prevent nausea, vomiting and pain after laparoscopy. Can J Anesth 50(5):440–444PubMedCrossRefGoogle Scholar
  8. 8.
    Cook R, Anderson S, Riseborough M et al (1990) Intravenous fluid load and recovery. A double-blind comparison in gynaecological patients who had day-case laparoscopy. Anaesthesia 45(10):826–830PubMedCrossRefGoogle Scholar
  9. 9.
    Halpin D (2004) NICE guidance for COPD. Thorax 59(3):181–182PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Alexander JI (1997) Pain after laparoscopy. Br J Anaesth 79(3):369–378PubMedCrossRefGoogle Scholar
  11. 11.
    Wills VL, Hunt DR (2000) Pain after laparoscopic cholecystectomy. Br J Surg 87(3):273–284PubMedCrossRefGoogle Scholar
  12. 12.
    Stanley IR, Laurence AS, Hill JC (2002) Disappearance of intraperitoneal gas following gynaecological laparoscopy. Anaesthesia 57(1):57–61PubMedCrossRefGoogle Scholar
  13. 13.
    Jackson SA, Laurence AS, Hill JC (1996) Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 51(5):485–487PubMedCrossRefGoogle Scholar
  14. 14.
    Mouton WG, Bessell JR, Otten KT et al (1999) Pain after laparoscopy. Surg Endosc 13(5):445–448PubMedCrossRefGoogle Scholar
  15. 15.
    Sajid MS, Mallick AS, Rimpel J et al (2008) Effect of heated and humidified carbon dioxide on patients after laparoscopic procedures: a meta-analysis. Surg Laparosc Endosc Percutan Tech 18(6):539–546PubMedCrossRefGoogle Scholar
  16. 16.
    Gurusamy KS, Samraj K, Davidson BR (2009) Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD006930.pub2
  17. 17.
    Tiel RLKD (ed) (1996) Peripheral nerve trauma. Butterworth-Heinemann, BostonGoogle Scholar
  18. 18.
    Qamar MI, Read AE (1987) Effects of exercise on mesenteric blood flow in man. Gut 28(5):583–587PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Sreenarasimhaiah J (2003) Diagnosis and management of intestinal ischaemic disorders. BMJ 326(7403):1372–1376PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Caldwell CB, Ricotta JJ (1987) Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 43(1):14–20PubMedCrossRefGoogle Scholar
  21. 21.
    Akca O, Melischek M, Scheck T et al (1999) Postoperative pain and subcutaneous oxygen tension. Lancet 354(9172):41–42PubMedCrossRefGoogle Scholar
  22. 22.
    Heughan C, Ninikoski J, Hunt TK (1972) Effect of excessive infusion of saline solution on tissue oxygen transport. Surg Gynecol Obstet 135(2):257–260PubMedGoogle Scholar
  23. 23.
    Williams EL, Hildebrand KL, McCormick SA et al (1999) The effect of intravenous lactated Ringer’s solution versus 0.9 % sodium chloride solution on serum osmolality in human volunteers. Anesth Analg 88(5):999–1003PubMedGoogle Scholar
  24. 24.
    Prien T, Backhaus N, Pelster F et al (1990) Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth 2(5):317–323PubMedCrossRefGoogle Scholar
  25. 25.
    Van Krutchen PM, Vermelis JMFW, Herold I et al (2010) Hypotonic and isotonic fluid overload as a complication of hysteroscopic procedures: two case reports. Minerva Anesthesiol 76:373–377Google Scholar
  26. 26.
    Walsh SR, Walsh CJ (2005) Intravenous fluid-associated morbidity in postoperative patients. Ann R Coll Surg Engl 87:126–130PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Arieff AI (1999) Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest 115(5):1371–1377PubMedCrossRefGoogle Scholar
  28. 28.
    Lowell JA, Schifferdecker C, Driscoll DF et al (1990) Postoperative fluid overload: not a benign problem. Crit Care Med 18(7):728–733PubMedCrossRefGoogle Scholar
  29. 29.
    Hillebrecht A, Schulz H, Meyer M et al (1992) Pulmonary responses to lower body negative pressure and fluid loading during head-down tilt bedrest. Acta Physiol Scand Suppl 604:35–42PubMedGoogle Scholar
  30. 30.
    Prisk GK, Olfert IM, Arai TJ et al (2010) Rapid intravenous infusion of 20 ml/kg saline does not impair resting pulmonary gas exchange in the healthy human lung. J Appl Physiol 108(1):53–59PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Collins JV, Cochrane GM, Davis J et al (1973) Some aspects of pulmonary function after rapid saline infusion in healthy subjects. Clin Sci Mol Med 45(3):407–410PubMedGoogle Scholar
  32. 32.
    Hayes I, Rathore R, Enohumah K et al (2012) The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery-a prospective randomized trial. BMC Anesthesiol 12(1):15PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Holte K, Jensen P, Kehlet H (2003) Physiologic effects of intravenous fluid administration in healthy volunteers. Anesth Analg 96(5):1504–1509PubMedCrossRefGoogle Scholar
  34. 34.
    Holte K, Kristensen BB, Valentiner L et al (2007) Liberal versus restrictive fluid management in knee arthroplasty: a randomized, double-blind study. Anesth Analg 105(2):465–474PubMedCrossRefGoogle Scholar
  35. 35.
    Holte K, Klarskov B, Christensen DS et al (2004) Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg 240(5):892–899PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Holte K, Foss NB, Andersen J et al (2007) Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth 99(4):500–508PubMedCrossRefGoogle Scholar
  37. 37.
    Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362(9399):1921–1928PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  • B. D. Straub
    • 1
  • A. Aslani
    • 1
  • K. Enohumah
    • 1
  • R. Rahore
    • 1
  • I. Conrick-Martin
    • 1
  • D. Kumar
    • 1
  • M. Campbell
    • 1
  • P. Dicker
    • 2
  • E. Mocanu
    • 1
    • 2
  • J. P. Loughrey
    • 1
  • N. E. Hayes
    • 1
  • C. L. McCaul
    • 1
    • 3
  1. 1.Department of Anesthesia, The Rotunda HospitalDublin 1Ireland
  2. 2.Royal College of Surgeons in IrelandDublinIreland
  3. 3.School of Medicine and Medical Science, University College DublinDublinIreland

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